Dzsinich Csaba, Szolnoky Jenő, Vallus Gábor, Darabos Gábor, Nyiri Gabriella, Teknős Dániel
Szív-, Ér- és Mellkassebészeti Osztály, Magyar Honvédség Egészségügyi Központ 1134 Budapest, Róbert K. krt. 44.
Magy Seb. 2017 Mar;70(1):32-42. doi: 10.1556/1046.70.2017.1.5.
Aortic dissection is a life threatening cardiovascular catastrophy. Its incidence estimated to 5-6 cases per 100,000 patients/year. The intimal tear happens at the ascending aorta in Type A, meanwhile at the aortic isthmus in Type B, but entry point may develop anywhere alongside the entire aorta. All types may affect a short aortic segment resulting in a localized false aneurysm, others separate the intimal layer at longer extension down to the visceral segment and far beyond to the femoral arteries. Dissection of orifices of side branches may lead to cerebral, upper extremity, spinal, visceral, renal and lower extremity malperfusion. These complications beyond the aortic rupture contribute significantly to high mortality of dissection. Today, first line treatment option in Type A dissection is surgery, but it can be endovascular or medical in Type B dissection. However, awareness of surgical procedures in this field remains inevitable. In this paper we summarize the surgical options for distal malperfusion affecting spinal, visceral, renal and lower extremity circulation.
主动脉夹层是一种危及生命的心血管急症。其发病率估计为每10万名患者每年5 - 6例。A型主动脉夹层的内膜撕裂发生在升主动脉，而B型发生在主动脉峡部，但破口可能出现在整个主动脉的任何部位。所有类型都可能累及较短的主动脉段，形成局限性假性动脉瘤，其他类型则在内膜层更长距离延伸，直至内脏段并远至股动脉。分支开口处的夹层可导致脑、上肢、脊髓、内脏、肾和下肢灌注不良。这些主动脉破裂以外的并发症是导致夹层高死亡率的重要原因。如今，A型夹层的一线治疗选择是手术，但B型夹层可以采用血管腔内治疗或药物治疗。然而，了解该领域的手术操作仍然是必不可少的。在本文中，我们总结了影响脊髓、内脏、肾和下肢循环的远端灌注不良的手术选择。
